Prognostic models for surgical-site infection in gastrointestinal surgery: systematic review.

BACKGROUND: Identification of patients at high risk of surgical-site infection may allow clinicians to target interventions and monitoring to minimize associated morbidity. The aim of this systematic review was to identify and evaluate prognostic tools for the prediction of surgical-site infection in gastrointestinal surgery. METHODS: This systematic review sought to identify original studies describing the development and validation of prognostic models for 30-day SSI after gastrointestinal surgery (PROSPERO: CRD42022311019). MEDLINE, Embase, Global Health, and IEEE Xplore were searched from 1 January 2000 to 24 February 2022. Studies were excluded if prognostic models included postoperative parameters or were procedure specific. A narrative synthesis was performed, with sample-size sufficiency, discriminative ability (area under the receiver operating characteristic curve), and prognostic accuracy compared. RESULTS: Of 2249 records reviewed, 23 eligible prognostic models were identified. A total of 13 (57 per cent) reported no internal validation and only 4 (17 per cent) had undergone external validation. Most identified operative contamination (57 per cent, 13 of 23) and duration (52 per cent, 12 of 23) as important predictors; however, there remained substantial heterogeneity in other predictors identified (range 2-28). All models demonstrated a high risk of bias due to the analytic approach, with overall low applicability to an undifferentiated gastrointestinal surgical population. Model discrimination was reported in most studies (83 per cent, 19 of 23); however, calibration (22 per cent, 5 of 23) and prognostic accuracy (17 per cent, 4 of 23) were infrequently assessed. Of externally validated models (of which there were four), none displayed 'good' discrimination (area under the receiver operating characteristic curve greater than or equal to 0.7). CONCLUSION: The risk of surgical-site infection after gastrointestinal surgery is insufficiently described by existing risk-prediction tools, which are not suitable for routine use. Novel risk-stratification tools are required to target perioperative interventions and mitigate modifiable risk factors.

This study is about finding ways to predict if someone will get an infection after having surgery on their stomach and intestines. If doctors know who is at high risk of getting an infection, they can take steps to prevent it and help the patient recover faster. The researchers looked at all the recent studies that have tried to predict who might get an infection after surgery. They found 23 studies that were good enough to look at in more detail. The researchers found that the studies they looked at were not very good at predicting who might get an infection. Most of the studies did not even check if their predictions were accurate. The few studies that did check were not very good at it. This means that doctors cannot use these predictions to help their patients. This means that doctors need to find better ways to predict who might get an infection after surgery on their stomach and intestines. If they can do this, they can help their patients recover faster and avoid problems like infections.

A Prospective, Observational Cost Comparison of Laparoscopic and Open Appendicectomy in Three Tertiary Hospitals in Nigeria.

BACKGROUND: The clinical benefits of laparoscopic appendicectomy are well recognized over open appendicectomy. However, laparoscopic procedures are not frequently conducted in many low-and middle-income countries (LMICs) for several reasons, including perceived higher costs. The aim of this study was to assess the feasibility and cost of laparoscopic appendicectomy compared to open appendicectomy in Nigeria. METHODS: A multicenter, prospective, cohort study among patients undergoing appendicectomy was conducted at three tertiary hospitals in Nigeria. Data were collected from October 2020 to February 2022 and analyses compared the average healthcare costs at 30 days after surgery. Quantile regression was conducted to identify variables that had an impact on the costs, reported in Nigerian Naira (Naira) and US dollars ($), with standard deviations (SD). FINDINGS: This study included 105 patients, of which 39 had laparoscopic appendicectomy and 66 had open appendicectomy. The average healthcare cost of laparoscopic appendicectomy (147,562 Naira (SD: 97,130) or $355 (SD: 234)) was higher than open appendicectomy (113,556 Naira (SD: 88,559) or $273 (SD: 213)). The average time for return to work was shorter with laparoscopic than open appendicectomy (mean: 8 days vs. 14 days). At the average daily income of $5.06, laparoscopic appendicectomy was associated with 9778 Naira or $24 cost savings in return to work. Further, 5.1% of laparoscopic appendicectomy patients had surgical site infections compared to 22.7% for open appendicectomy. Regression analysis results showed that laparoscopic appendicectomy was associated with $14 higher costs than open appendicectomy, albeit non-significant (p = 0.53). INTERPRETATION: Despite selection bias in this real-world study, laparoscopic appendicectomy was associated with a slightly higher overall cost, a lower societal cost, a lower infection rate, and a faster return to work, compared to open appendicectomy. It is technically and financially feasible, and its provision in Nigeria should be expanded.

Single-phase CT angiography predicts ASPECTS decay and may help determine when to repeat CT before thrombectomy.

OBJETIVES: Time is relative in large-vessel occlusion acute ischemic stroke (LVO-AIS). We aimed to evaluate the rate of inter-hospital ASPECTS decay in patients transferred from a primary (PSC) to a comprehensive stroke center (CSC); and to identify patients that should repeat computed tomography (CT) before thrombectomy. MATERIALS AND METHODS: This was a retrospective cohort study of consecutive anterior circulation LVO-AIS transferred patients. The rate of ASPECTS decay was defined as (PSC-ASPECTS - CSC-ASPECTS)/hours elapsed between scans. Single-phase CT angiography (CTA) at the PSC was used to classify the collateral score. We compared patients with futile versus useful CT scan re-evaluation. RESULTS: We included 663 patients, of whom 245 (37.0%) repeated CT at a CSC. The median rate of ASPECTS decay was 0.4/h (0.0-0.9). Patients excluded from thrombectomy after a CT scan repeat (n=64) had a median ASPECTS decay rate of 1.18/h (0.83-1.61). Patients with absent collateral circulation had a median rate of 1.51(0.65-2.19). The collateral score was an independent predictor of the ASPECTS decay rate (aß = -0.35; 95%CI -0.45 - -0.19, p<0.001). Age (aOR: 1.04 95% CI 1.02-1.07, p<0.001), NIHSS (aOR: 1.11 95% CI 1.06-1.15, p<0.001), PSC ASPECTS (aOR: 0.74 95% CI 0.60-0.91, p=0.006) and the CTA collateral score (aOR: 0.14 95% CI 0.08-0.22, p<0.001) were independent predictors of the usefulness of a CT scan repeat. CONCLUSIONS: The rate of ASPECTS decay can be predicted by the CTA collateral score, helping in the selection of patients that would benefit from repeating a CT assessment on arrival at the CSC.

A giant cause of recurrent fever.

A 73-year-old male patient presented to the Emergency Department with history of weight loss, dysphagia, and recurrent fever. The initial chest radiograph showed a mediastinal hypotransparency and to the complaints of dysphagia the patient did a barium swallow test that revealed a giant Zenker diverticulum. Apart from mildly elevated inflammatory markers and despite the extensive investigation of recurrent fever, no other relevant features were found either in blood analysis, microbiological cultures or computerized tomography. He was submitted to surgical intervention, with no recurrence of fever afterwards. It was assumed that food debris and possible microaspirations were responsible for the recurrence of fever and elevation of inflammatory markers. The patient eventually died due to late complications of surgery. Although recurrent fever is frequently linked to systemic disease, the presence of such a giant diverticulum was probably causing an inflammatory response that is usually not seen in these conditions.

Adolescent girls' body appreciation: influences of compassion and social safeness, and association with disordered eating.

PURPOSE: Adolescence has been stated as a period in which body image and eating difficulties' have its greatest expression, especially in females. Nonetheless, protective factors, such as body appreciation and compassion, are not thoroughly studied in this developmental stage. The current study hypothesized that competences for self-compassion and receiving others' compassion associate positively with social safeness, and the three variables with body appreciation. Moreover, the association between body appreciation and disordered eating was analysed. A sample of Portuguese female adolescents was used. METHODS: 205 participants, aged between 12 and 18, completed a set of self-report measures in the school context. Data were explored via descriptive, correlational and path analysis. RESULTS: Path analysis indicated that self-compassion and receiving compassion from others associate positively with feelings of social safeness which, in turn, associate with higher body appreciation. All the variables in study associated indirectly and negatively with disordered eating, and body appreciation presented a direct and negative association with disordered eating. CONCLUSION: Findings of the current study may suggest the pertinence of developing programs for female adolescents that include the cultivation of compassionate and affiliative skills to promote positive body image and to prevent or intervene with disordered eating symptoms, with potential effects on overall well-being and mental health. LEVEL OF EVIDENCE: Cross-sectional descriptive study, Level V.

Baseline anaemia increases locally advanced rectal cancer mortality in older patients undergoing preoperative chemoradiation.

PURPOSE: The median diagnosis age of rectal cancer (RC) is 70 years old. The standard of care for locally advanced RC (LARC) is preoperative chemoradiation (CRT) followed by surgery. Anaemia is a frequent condition in older patients but is not a pure consequence of ageing. METHODS: The patients aged 65 years or over, with clinical stage II/III LARC, and treated with preoperative concurrent CRT were retrospectively reviewed. Baseline haemoglobin (Hb) levels were collected. RESULTS: One hundred and seven patients enrolled in this study, but 17 were excluded in relation with treatment disruption. Fifty-seven (63.3%) males and 33 (36.7%) females completed preoperative CRT whose median age at diagnosis was 73. Twenty-five (27.8%) patients presented with anaemia at rectal cancer diagnosis, and median Hb was 13.5 g/dL (IQR = 1.45) and 11.2 g/dL (IQR = 1.35), for non-anaemic and anaemic patients, respectively. For the enrolled older population, only 2 patients reported acute grade 3 toxicity. Baseline anaemia tended to decrease the LARC-free interval and was associated with a significantly higher hazard of all-cause and LARC mortality, approximately 5 times (HR = 5.25; 95% CI 1.48-18.66) and 10 times (HR = 10.09; 95% CI 2.40-42.48), respectively. Patients older than 75 presented a significantly negative impact on overall survival (OS) and LARC-specific survival (HR = 6.20, 95% CI 2.00-19.22; and HR = 7.61, 95% CI 2.08-27.87, respectively). Conversely, no significant impact was found for age-adjusted Charlson comorbidity index on OS, LARC-specific survival and LARC-free interval. CONCLUSIONS: Overall and LARC-specific survival were significantly lower for the baseline anaemic older patients and for those aged 75 years or over.

The soothing-affiliation system and body appreciation: recollected and present affect.

Attachment and affiliation-related affect has been stated to be a powerful regulator of human development, maturation, well-being and health. Accordingly, as research on positive body image has evolved, data on the association between non-judgmental interpersonal relationships and body appreciation has emerged. The present study sought to explore a model linking memories of early affiliative relationships with body appreciation via higher current social safeness and the experience of positive affect in a sample of Portuguese women aged between 18 and 50 years (N = 286). Online data collection occurred throughout 2017. The multivariate analyses of the hypothesized model revealed good fit to the data, and results showed that early memories of warmth and safeness were associated with body appreciation via higher current social safeness and higher safeness/contentment affect. Safeness/contentment affect was the positive affect revealed as being more strongly related to body appreciation. These results provide strong support for the importance of early and current emotional bonds for women's body appreciation and suggest that therapists should consider the cultivation of affiliation skills when promoting positive body image.

Self-to-others and self-to-self relationships: paths to understanding the valence of body image and eating attitudes in emerging adult women.

PURPOSE: Interpersonal and intrapersonal factors contributing to body appreciation in emerging adult women remain poorly explored. Thus, the present study aimed to test the impact of early memories of warmth and safeness with peers, self-compassion, and social safeness, in body appreciation and in disordered eating attitudes and behaviours. METHODS: A total of 387 women aged between 18 and 25 completed a set of self-report questionnaires. Data were analysed through descriptive and correlation statistics, and the suitability of a theoretical model was explored via path analysis. Self-report instruments assessed participants' weight and height, early memories of warmth and safeness with peers, self-compassion, social safeness, body appreciation, as well as disordered eating. RESULTS: Early memories of warmth and safeness with peers associated with higher self-compassion and feelings of social safeness, which were both positively linked to body appreciation. Body appreciation associated with a lower display of disordered eating. CONCLUSION: It seems that childhood and adolescent experiences may have an important influence on the development of self-to-self and self-to-others secure relationships, with consequences on the way women behave and relate with their unique body characteristics. The pertinence of developing self-compassion and affiliative skills to promote positive body image among females is suggested, as well as of applying compassion-based strategies when clinically approaching symptoms of eating disorders. LEVEL OF EVIDENCE: Cross-sectional descriptive study, Level V.

Striving as a paradoxical strategy to deal with fears of compassion: impact on disordered eating.

PURPOSE: Recent literature has documented the relationship between fears of compassion and disordered eating attitudes and behaviours. However, research on the processes underlying this association is still in the early stages. As such, this study tested a mediator model where insecure striving and inflexible eating (i.e. psychological inflexibility focused on eating) were hypothesized to mediate the impact of fears of compassion on the severity of disordered eating, while controlling for the effects of body mass index and age. METHODS: The study's sample comprised 310 Portuguese women from the general population, aged between 18 and 65 years, who completed an online survey. RESULTS: Path analysis results revealed that the impact of fear of compassion for self and for others on disordered eating was fully mediated by insecure striving and inflexible eating, whereas the impact of fear of compassion from others was only partly mediated by these processes. The tested model accounted for 48% of disordered eating's variance and presented excellent fit indices. CONCLUSIONS: These results suggest that fears of experiencing compassion may preclude the experience of social safeness, hindering the activation of social mentalities other than rank-focused mentality. Maladaptive competitive strategies may ensue (insecure striving), such as inflexible eating, which is linked to the development of disordered eating. In terms of clinical implications, these findings stress the need to effectively assess and address fears of compassion, as they not only seem to be involved in the development of disordered eating, but also have been reported to be significant predictors of poor treatment outcomes. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Exploring the paths between self-compassionate attributes and actions, body compassion and disordered eating.

The relationship between self-compassion and well-being and health (e.g. a lower proneness for eating-related disturbances) is well stressed in the literature. However, the specific contribution of self-compassionate attributes, actions, and body compassion remains scarcely studied. The main aim of the present study was to examine whether the link between self-compassionate attributes and disordered eating attitudes and behaviours is mediated by self-compassionate actions and body compassion, in a sample of 299 Portuguese women from the general population. The tested model explained 44% of eating psychopathology's variance and presented excellent fit indices. The most interesting contribution of this study was the suggestion that the ability to act in accordance with self-compassionate attributes is associated with higher levels of body compassion, that is, an attitude of appreciation, acceptance, warmth toward body-related thoughts, perceptions and feelings, which reflects in a lower susceptibility to adopt disordered eating attitudes and behaviours. These results seem to offer an important contribution for research and clinical practice by supporting the importance of including strategies to develop self-compassionate skills and body compassion competencies in prevention and treatment programs in the area of eating psychopathology.Level of evidence Level III, evidence obtained from a well-designed cohort.

Body compassion safeguards against the impact of major life events on binge eating.

Body compassion is a fresh construct that incorporates two multidimensional concepts: body image and self-compassion. Although self-compassion has revealed a protective role against body image and eating-related problems (e.g., binge eating), the study of this specific compassionate competence focused on body image is still largely unexplored. The present study aimed to test two moderation models which hypothesized that body compassion moderates the impacts of (i) the cumulative number and (ii) negative appraisal of major life events on binge eating behaviours, in a sample of 458 women from the Portuguese general population. Results showed that body compassion was negatively associated with major life events and binge eating. Moderation analysis results demonstrated the moderator effect of body compassion on the relationship between major life events (both cumulative number and negative appraisal) and binge eating, accounting for 34% and 33% of the variance of binge eating, respectively. The moderator effect of body compassion was confirmed to low to medium levels of body compassion and, overall, results seem to suggest that, for the same levels of major life events (in number or negative appraisal), women who present higher body compassion present less binge eating symptoms. Although these data are preliminary and need support from a longitudinal design research, current findings appear to be promising by suggesting the relevance of promoting body compassion in prevention and treatment programs for disordered eating attitudes and behaviours.

The relation of early positive emotional memories to women's social safeness: The role of shame and fear of receiving compassion.

Early affiliative experiences play an important role in social and emotional development. Several authors have suggested that early positive experiences may be recorded as memories of warmth and soothing. However, the relationship between such memories and current feelings of social safeness and connectedness remains scarcely studied. The current study examined the association between recall of early positive affiliative experiences (with family and peers) and women's social safeness. External shame and fear of others' compassion were hypothesized to be mediators in these associations. The sample was recruited from October 2016 to February 2016 and included 400 women from the Portuguese population, aged between 18 and 55 years. The path model explained 52% of the variance of social safeness. Early positive affiliative memories (with family and peers) were associated with a lower tendency to fear receiving others' compassion and to feel ashamed, which seemed to be associated with an increased sense of social safeness. These findings offer pertinent insights for future studies in and interventions for women´s well-being and mental health by highlighting the importance of addressing shame and fears of compassion when working with women who tend to perceive their social world as unsafe and others' compassion as threatening.

Developments on committed action: Validity of the CAQ-8 and analysis of committed action's role in depressive symptomatology in breast cancer patients and healthy individuals.

Committed action, a process of acceptance and commitment therapy's psychological flexibility model, is considered an understudied construct that currently can only be measured by one instrument, the Committed Action Questionnaire (CAQ-8). This study aims at analysing the psychometric properties of the CAQ-8 in healthy individuals and breast cancer patients. This study also aims to explore the specific meditational role of committed action in the well-established relationship between experiential avoidance and depression symptoms. The healthy sample comprised 294 adults from the general population, and the breast cancer samples comprised 82 participants. Both groups completed the validated self-report measures. CAQ-8's robustness was examined through validity analyses, confirmatory factor analyses, and multigroup analysis. The meditational model was conducted using structural equation modelling. The CAQ-8 presented good internal consistency and construct, convergent, concurrent, and divergent validity in both samples. Further, the CAQ-8 showed incremental validity over a measure of engaged living. Findings also demonstrated measurement invariance between healthy individuals and breast cancer patients. Regarding the conducted meditational model that was also invariant between the two analysed groups, it was demonstrated that part of the effect that experiential avoidance holds on depressive symptomatology is explained by committed action. This study suggests that the CAQ-8 is adequate for use in healthy and cancer populations. Moreover, it provides novel, empirical support regarding the links between committed action, experiential avoidance, and depressed mood, being also the first investigation to particularly study committed action in a cancer population. Implications for theory and practice are discussed.

Chronic illness-related cognitive fusion explains the impact of body dissatisfaction and shame on depression symptoms in breast cancer patients.

Breast cancer is linked to psychological distress and mood disorders that are in turn associated with higher psychological dysfunction and decreased breast cancer survival. It is considered that psychological health in breast cancer is considerably affected by body image impairment, which in turn seems to be highly associated with shame. However, the impact of these variables on mental health may not be direct. The current study aimed to explore a comprehensive model regarding the role of chronic illness-related cognitive fusion in the relationship of body image dissatisfaction and chronic illness-related shame with depression symptoms. The sample was composed of 75 women with nonmetastatic breast cancer, recruited in a Radiotherapy Service in central Portugal. The conducted path model presented an excellent fit and accounted for 59% of the variance of depressive symptomatology. Further, it demonstrated that body image dissatisfaction's impact on depressed mood is significantly explained by the mechanisms of chronic illness-related shame and chronic illness-related cognitive fusion. It was also revealed that chronic illness-related cognitive fusion additionally mediated the impact of chronic illness-related shame on depression. These findings are suggestive of the importance of body image and chronic illness shame in the determination of breast cancer patients' depression symptoms and also the central role of chronic illness-related cognitive fusion in these relationships. Therefore, the implementation of acceptance and defusion-based psychotherapeutic interventions to improve mental health in cancer patients seems to be of great importance.

Shame and eating psychopathology in Portuguese women: Exploring the roles of self-judgment and fears of receiving compassion.

Shame has been for long associated with the development and maintenance of body image and eating-related difficulties. However, the mechanisms underlying this association remain unclear. Therefore, the current study sought to examine the mechanisms of self-judgment and fears of receiving compassion from others in the association between external shame and disordered eating, while controlling for body mass index (BMI). Participants in this study were 400 women from the general population, aged between 18 and 55 years old. Correlation analyses revealed significant and positive relationships between external shame, self-judgment, fears of receiving compassion from others and eating psychopathology. A path analysis confirmed that, when controlling for the effect of BMI, external shame has a direct effect on disordered eating severity, and also an indirect effect, mediated by higher levels of self-judgment and increased fears of receiving others' kindness and compassion. Results showed the plausibility of the tested model which explained 36% of the variance of disordered eating. These findings seem to support that women who perceive that others view them negatively tend to be defensive and engage in maladaptive emotion regulation strategies (such as harsh critical attitudes towards the self and being resistant to others' compassion), which may trigger maladaptive eating attitudes and behaviours. The current research appears to be an innovative study in the field of body image and eating-related psychopathology and seems to represent a new avenue for future research and for the development of intervention programs.

Repetitive eating questionnaire [Rep(eat)-Q]: Enlightening the concept of grazing and psychometric properties in a Portuguese sample.

BACKGROUND/OBJECTIVE: Grazing has been associated with poor weight loss or weight regain in obese patients undergoing bariatric surgery, but research remains scarce and complicated by the use of different non-validated measures. The aim of this paper is to describe the validation of the Rep(eat)-Q, a self-report measure developed to assess grazing, and investigates its relationship with BMI and psychopathology. SUBJECTS/METHODS: 1223 university students and community participants (non-clinical; Study A) and 154 pre-bariatric and 84 post-bariatric patients (Study B) completed a set of self-report measures, including the Rep(eat)-Q (worded in Portuguese), to assess disordered eating, depression, anxiety, stress and impulsivity. Exploratory and confirmatory factor analyses tested the factor structure; internal consistency construct, convergent and divergent validity were also tested. RESULTS: The Rep(eat)-Q scales showed good internal consistency (α ≥ 0.849) and temporal stability (rsp = 0.824, p < 0.000). Factor analyses generated two subscales: compulsive grazing and repetitive eating. Significant correlations (p < 0.05) were found between the Rep(eat)-Q and BMI in the non-clinical population and weight loss and weight regain in the bariatric sample. Generally, the correlations with psychological distress were weak (rsp < 0.4). Strong and significant (rsp≥0.4; p's < 0.05) correlations were found between compulsive grazing and eating disorder psychopathology. Repetitive eating subscale was inversely correlated with cognitive restraint (rsp -0.321, p < 0.05) and directly correlated with uncontrolled eating and emotional eating (rsp = 0.754; rsp = 0.691; p < 0.05). DISCUSSION/CONCLUSION: The Rep(eat)-Q is a valid measure to assess grazing in non-clinical and in bariatric surgery populations. Grazing can be conceptualized on the spectrum of disordered eating behavior, and appears associated with loss of control over eating. Considering the link between grazing and weight outcomes, the Rep(eat)-Q represents a necessary strategy for the systematic screening of grazing.

Assessing positive emotional memories with peers: The Early Memories of Warmth and Safeness with Peers Scale for adolescents.

Research on the association between early positive relational experiences and later psychosocial adjustment is growing. The quality of peer relationships may have a particularly important effect on adolescents' wellbeing and mental health. The current study aimed at examining a measure of personal emotional memories of peer relationships characterized by warmth, safeness and affection, which occurred in childhood and adolescence (EMWSSPeers-A). Distinct samples (N = 584) of adolescents aged between 12 and 18 were used to assess the EMWSSPeers-A' factorial structure through a Principal Component Analysis and a Confirmatory Factor Analysis, and to analyse the scale's psychometric properties. Results indicated a one-dimensional structure with 12 items with very good internal consistency, and construct, convergent, divergent and incremental validities. By allowing the examination of the role played by memories of positive peer relationships on adolescents' psychological adjustment, the EMWSSPeers-A may be potentially useful for future model testing and for the assessment of interventions.

How can the recall of early affiliative memories with peers influence on disordered eating behaviours?

The present study aimed to explore the role of early affiliative memories with peers on the adoption of disordered eating attitudes and behaviours through the mechanisms of external shame and self-judgment. The sample used in the current study comprised 632 women from the community, aged between 18 and 60 years old.The tested model explained 22 % of eating psychopathology's variance and showed excellent model fit indices. Results indicated that the impact of the recall of early positive memories with peers on eating psychopathology was fully carried through the mechanisms of external shame and self-judgment. In fact, these findings seem to suggest that the lack of warm and safe affiliative memories with peers is linked to higher levels of shame (e.g., feelings of inferiority and inadequacy), and also to higher vulnerability to engage in maladaptive emotional strategies (such as self-judgmental attitudes), which appears to explain the increase of disordered eating behaviours.These findings contribute to the understanding of the impact of peer-related early affiliative memories in the engagement in disordered eating. Furthermore, this study has significant clinical implications, emphasizing the importance of targeting shame and maladaptive emotional strategies, especially in a context involving early adverse emotional experiences with peers.

Experiential avoidance versus decentering abilities: the role of different emotional processes on disordered eating.

In modern western societies, the female body is a predominantly used dimension in self and social evaluations. In fact, the perceived discrepancy between one's current and ideal body image may act as a pathogenic phenomenon on women's well-being. Furthermore, significant differences in the tendency to engage in disordered eating attitudes and behaviours have been verified between women sharing similar characteristics and perceptions about body's weight and shape, which suggests  that different emotion regulation processes may be involved in this association. This study thus aims to clarify the mediational effect of two different emotional regulation processes, experiential avoidance and decentering, on the association of weight and body shape-related variables  and shame with disordered eating, in a sample of 760 women. The tested path model explained 44 % of disordered eating attitudes and behaviours, and showed an excellent model fit. Results demonstrated that body mass index had a direct effect, albeit weak, on disordered eating behaviours, and that body-image discrepancy and shame presented indirect effects through the mechanisms of experiential avoidance and decentering. Results also revealed that experiential avoidance and decentering showed significant mediator effects on the relationship of weight and body shape and shame with disordered eating behaviours. These findings suggested that while experiential avoidance exacerbates the impact of weight and body shape and shame on disordered eating attitudes and behaviours, decentering seems to attenuate this association. Our findings appear to offer significant clinical and research implications, highlighting the importance of targeting maladaptive emotion processes and of the development of decentering abilities.

Endothelial dysfunction evaluated by peripheral arterial tonometry is related with peak TnI values in patients with ST elevation myocardial infarction treated with primary angioplasty.

PURPOSE: The role of endothelial-dependent function in patients with acute ST elevation myocardial infarction (STEMI) is not clear. Endothelial dysfunction may contribute to the pathophysiological processes occurring after STEMI and influence the extension of myocardial necrosis. Endothelial-dependent dysfunction evaluated by peripheral arterial tonometry (PAT) has already showed to be correlated with microvascular coronary endothelial dysfunction. Our purpose was to evaluate the impact of endothelial dysfunction on peak Troponin I (TnI) values, as a surrogate for the extension of myocardial infarction, in patients with STEMI treated with primary angioplasty (P-PCI). METHODS: 58 patients with STEMI treated with P-PCI (mean age 59.0 ± 14.0 years, 46 males) were included. Endothelial function was assessed by reactive hyperaemia index (RHI) determined by PAT. Patients were divided in two groups according to the previously reported RHI threshold for high risk (1.67). The extension of myocardial necrosis was evaluated by peak TnI levels. RESULTS: RHI median value was 1.78 (IQR0.74);25 patients had endothelial dysfunction (RHI b 1.67). The two groups had no significant differences in age, gender, main risk factors and pain-to-balloon time. Patients with an RHI b 1.67 had significant larger infarcts: TnI 73.5 ng/mL (IQR 114.42 ng/mL) versus TnI 33.2 ng/mL (IQR 65.2 ng/mL); p = 0.028. On multivariate analysis, the presence of an RHI b 1.67 kept significant impact on TnI peak values (p=0.02). CONCLUSIONS: The presence of endothelial-dependent dysfunction, assessed by PAT, is related with higher peak TnI values in STEMI patients treated with P-PCI. These results strength the possibility that endothelial-dependent dysfunction may be a marker of poor prognosis and eventually a therapeutic target in patients with STEMI.